Nursing as a Response to Human Vulnerability
of harm is compounded by their reliance upon others,
including institutional others, to protect them in ways
that are, generally speaking, unnecessary for ordinary
individuals. But this is already to identify a difficulty
in using vulnerable as an adjective in this way because
it fails to distinguish between ordinary and extraordi-
nary vulnerability.
In this paper I offer a preliminary analysis of
human vulnerability as it relates to those who find
themselves recipients of nursing practice in all its
forms. Tlte term ‘patient’ is used throughout to
describe such persons merely for pragmatic and sty-
listic reasons (I might equally have chosen client, ser-
vice user, or some other term) and no ideological
position nor practice orientation should be inferred.
Starting from the almost trite observation that all
people are vulnerable, I suggest categories of risks of
harm before considering some of the difficulties with
current use of the term vulnerable as applied to
patients. I will then build upon Clarke & Driever’s
(1983) analysis before claiming it is more appropriate
to describe patients as more-than-ordinarily vulnera-
ble. From this it is argued that nursing practice must
aim to provide patients with the sort of protection
from harm that enables, rather than hinders, human
flourishing.
All people are vulnerable ...
That human beings are vulnerable is a self-evident
truth. Vulnerability is part of the human condition;
harm may come from many sources and we are never
entirely free from the possibility of being harmed.
Despite our quest to be autonomous and indepen-
dent, it is apparent that any individual is limited in
her or his scope to reduce her or his vulnerability.
Ultimately, our efforts to minimize our vulnerability
are dependent upon the general good will of others.
We are especially vulnerable as infants. Other times
when we might be said to be particularly vulnerable
include: during sleep, when we are distracted and
when we find ourselves with a degree of physical
incapacity. While it is true to say that at such times
we are more vulnerable than when we are awake,
when we are not distracted and when we are physi-
cally fit respectively, it remains the case that the
examples describe parts of our ordinary everyday vul-
nerability.
This ordinary vulnerability is, in part, a function of
the uncertainty with which we live and this uncer-
tainty poses risks to our possibilities for flourishing.
We cannot be certain that those things on which we
depend will be there for us tomorrow. Nevertheless,
we tend to assume that if we go about our everyday
business following the normal social conventions we
will end the day relatively unscathed. But there is no
certainty about this and, as the Stoics remind us, if we
come to rely on the idea that all will go well for us
then our expectations will not only expose us to dis-
appointments but will also leave us ill-prepared to
deal with the harms that befall us1. Hence to ignore
our inherent vulnerability is ultimately counterpro-
ductive as it makes us more rather than less vulnera-
ble; or rather it renders us susceptible to fears about
the possibility of losing those things we most value.
And if we value the wrong things then our vulnera-
bility is increased and our sense of safety compro-
mised. The Stoics’ remedy to this possibility is to
suggest that we do not place value on those things for
which we cannot offer protection; those things, i.e.
that we fear are vulnerable to harm.
The danger in following this advice is that we may
come to accept events as inevitable and thus become
more vulnerable if we fail to take elementary and
simple measures to protect ourselves. If I were to
walk in the road rather than on the pavement in the
belief that what will happen to me today will happen
regardless of any action I might or might not take,
then it would appear that I have put myself at risk
unnecessarily. Under normal circumstances we do
tend to act so as to reduce or minimize our vulnera-
bility while recognizing that some of the reduction
stems from our trust in the social and political insti-
tutions upon which we rely to protect us from the
sorts of harms that lie beyond our immediate control.
1An easily accessible account of the Stoic philosophy of Seneca
can be found in De Botton ʌ. (2000) The Consolations of Phi-
losophy. Hamish Hamilton, London. For a more comprehensive
account of the origins and developments of Stoic philosophy see
Nassbaum M.C. (1994) The Therapy of Desire. Princeton Uni-
versity Press, New Jersey.
© Blackwell Publishing Ltd 2005 Nursing Philosophy, 6, pp. 2-Ю
213